| NPI | 1205421229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: AZ LCSW-21992) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM SWB-2024-0480) |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2026-03-11 |